MEDICARE: MICHIANA WOMEN'S CENTER, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	4301087947	MI

General Provider Information

NPI Number	:	1245251446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIANA WOMEN'S CENTER, PLLC

Provider Business Mailing Address
First Line	:	600 S LAKEVIEW ST
Second Line	:	SUITE 103
City	:	STURGIS
State	:	MI
Zip	:	49091-2371
Country	:	US
Telephone Number	:	269-651-8071
Fax Number	:	269-651-8239

Provider Business Practice Location Address
First Line	:	600 S LAKEVIEW ST
Second Line	:	SUITE 103
City	:	STURGIS
State	:	MI
Zip	:	49091-2371
Country	:	US
Telephone Number	:	269-651-8071
Fax Number	:	269-651-8239

Authorized Official
Title or Position	:	OWNER PHYSICIAN
Name	:	DR. WILSON SAWA
Credential	:	MD
Telephone Number	:	269-651-8071

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	08/22/2020

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